International Journal of Medical Students

Evaluating Hypoglossal Nerve Stimulation Outcomes in Obstructive Sleep Apnea: Impact of Predisposing Conditions in a Retrospective Cohort

2025-05-13T17:30:41-04:00

Background: This retrospective study aimed to analyze treatment outcomes for patients receiving a hypoglossal nerve stimulation (HNS) device for obstructive sleep apnea (OSA). Methods: Chart reviews were conducted for HNS patients who underwent a post-implantation polysomnography (PSG) (typically performed approximately 2 months after device activation) to assess therapeutic response and optimize stimulation settings. Patients were categorized into “green (GP)” (optimal response: AHI <15, ≥4 hours/night device use, and subjective benefit) and “yellow (YP)” (suboptimal response: failure to meet one or more of these criteria) response pathways. Results: Out of 111 patients assessed, 27 patients met pathway categorization criteria. 12 of those were classified in green and 15 in yellow. Median age and BMI were 63.9 years and 28.7 kg/m², respectively, with a balanced sex assigned at birth distribution. HNS treatment reduced median AHI by 85.6% (from 34.7 to 5.0) for the green pathway (GP), and by 87.4% (from 39.6 to 5.0) for the yellow pathway (YP). Patients who had at least one sleep-related comorbidity were more likely to be in the yellow pathway (p < .001). Comorbidities such as depression and insomnia were significantly associated with suboptimal treatment response (yellow pathway) (p = .003 and p = .02, respectively). Conclusions: This study emphasizes the significance of sleep-related comorbidities as a strong predictor of patient outcomes. More efficient utilization of resources may be achieved by considering comorbid conditions prior to HNS implantation. Given the small sample size and retrospective single-institution design, these findings should be interpreted with caution and may not be generalizable to broader populations.

Sculpting the Science: Teaching Anatomy of the Facial Muscles to Medical Students

2024-09-16T15:46:16-04:00

Background: Clay-modeling in anatomy education is an engaging activity that complements cadaveric dissections. The post-COVID-19 cadaver shortage further necessitates alternative practical modalities.

Methods: A student-centred clay-modeling practical activity was developed towards the study of the muscles of facial expression due to a shortage of cadaveric material. Student feedback in the form of a questionnaire with closed- and open-ended questions.

Results: Thematic analysis was manually performed to generate the primary and secondary themes associated with the open-ended questions. Four themes were generated: fun, collaboration, active learning, and bittersweet. Closed-ended questions revealed that respondents found the activity motivational and enjoyable. Feeling around the disassembly of students' anatomical models was of particular interest. Some students expressed emotions of sadness and others stated that they felt devastated.

Conclusion: The outcome of this study presents the opportunity for further work to link discussions around the humanistic considerations of anatomy and the study of human remains, utilizing clay modelling as a crucial resource.

Evaluating a Low-Fidelity Anesthesiology Simulation for Airway Management and Cardiac Arrest in Medical Students

2025-03-04T22:08:50-05:00

Background: Low-fidelity simulations are cost-effective, accessible tools for medical education. This study describes the development and initial implementation of a low-cost, easy-to-run simulation, assesses participant performance in airway management and ACLS, and reviews qualitative feedback to refine future iterations.

Methods: This single-center, prospective observational study piloted a low-fidelity simulation on difficult airway management and intraoperative cardiac arrest for fourth-year medical students in a three-hour workshop. Participant demographics, simulation performance, and post-simulation feedback were analyzed using proportions and Fisher’s exact test.

Results: A total of eleven medical students participated in the simulation, with most participants scoring in the higher range. No statistically significant findings using the Fisher’s exact test were detected between student performance and past experiences in related fields of anesthesiology, critical care medicine, or emergency medicine. Learners had the most difficulty with adherence to ACLS pathways when managing a simulated cardiac arrest, scoring on average 4.5 ± 1.6 points out of 8. Six of the eleven participants completed the post-simulation survey (55% response rate), primarily giving positive feedback, with all responses indicating agreement that low-fidelity simulations are beneficial learning opportunities for medical students, citing them as helpful to review knowledge.

Conclusion: Low-fidelity simulations provide an underutilized yet effective means for skill development in medical education. ACLS performance gaps may stem from limited practice or situational stress. This simulation requires minimal resources and personnel, making it easily adoptable. Future improvements include a larger sample size, clearer questions, and preparatory materials.

Exploring Wonder in Medical School Admissions: Correlations with Admissions Decisions

2024-11-05T15:22:34-05:00

Background: The capacity for wonder (CfW), which has been proposed as an important personal disposition for clinicians, may provide a meaningful picture of medical school applicants. The purpose of our study was to explore experiences of wonder among applicants and their association with components of the admissions process.

Methods: The Johns Hopkins School of Medicine asks applicants to submit an essay about a time they experienced wonder in their everyday life. Among applicants who were interviewed in the 2021-2022 cycle, we analyzed an anonymized 50% random sample of essays (n = 224). Essays were coded using the validated CfW scale and categorized by topic. Standard bivariate statistical tests were used to assess whether the extent of wonder was associated with admissions decisions and interview scores.

Results: Among applicants who were admitted, 80% had scores reflecting “high wonder,” 62% had “medium wonder” scores, and 27% had “low wonder” scores. Applicants’ extent of wonder was significantly associated with their admissions decisions (p < 0.0002), mean interview scores (p = 0.00025), and mean scores in research portfolio (p < 0.0001). Six broad essay topics were identified: connecting with others, engaging in art, experiences in nature, engaging in wellness, the pursuit of knowledge, and sports/exercise.

Conclusion: Applicants’ capacity for wonder may be a relevant consideration in the admissions process. Future research should verify our findings at other institutions, investigate other components of the medical school application that may be associated with the capacity for wonder, and explore interventions to cultivate wonder throughout medical education.

A Nationwide Evaluation of U.S. Geriatric Fellowship Websites: Assessing Program Information Availability

2025-04-12T09:28:15-04:00

Introduction: Prospective students interested in any medical fellowship seek out program information in order to help them make application and attendance decisions. Additionally, the field of geriatric medicine is traditionally underserved in the United States, and attending geriatric fellowship programs can make a great impact in improving this population’s care. The purpose of this study was to examine geriatric medicine fellowship program websites and assess their available information for prospective fellows. Methods: Using the Electronic Residency Application Services (ERAS), a list of websites was created of U.S. institutions offering Accreditation Council for Graduate Medical Education (ACGME)-accredited geriatric programs also participating in the National Residency Matching Program (NRMP, or “the Match”). Every website was evaluated for 8 items of application information such as application deadlines, program director/coordinator contact information, and a list of application requirements and 17 items of program information, such as compensation, locations of service, and rotation schedule. Results: In total, 103 programs were assessed in this study. Overall, the information most often listed on these fellowship websites were program affiliation (100%), training sites (88.3%), and program coordinator’s contact (83.5%). In total, only 51% and 45% of all application and program information, respectively, was available according to the assessment criteria. There is a clear lack of information for prospective fellows to access. Conclusion: In order to help increase fellow attendance, adequate information must be available. With the increasing geriatric population, there will be an increased need for fellowship-trained physicians trained in geriatric medicine to serve them

A Comparative Cross-Sectional Study on the Prevalence of Impostor Phenomenon in Medical and Non-Medical Students of Lahore City, Pakistan

2024-10-30T14:46:37-04:00

Background: The Impostor Phenomenon (IP) is a psychological pattern characterized by feelings of inadequacy and self-doubt despite evident competence. This study aims to compare the prevalence of Impostor Phenomenon among medical and non-medical students in Lahore, Pakistan and to compare the distribution between genders.

Methods: A cross-sectional study involving a total of 242 medical and non-medical students was conducted using the validated Clance Impostor Phenomenon (CIP) scale that ranges between 20 to 100 and includes scores categorised as ≤40 (mild), 41-60 (Moderate), 61-80 (Frequent), ≥81 (Severe). The data was collected between February 2023 to April 2023. It was analyzed using descriptive statistics and unpaired t-tests as well as multivariate linear regression model in SPSS version-26.

Results: IP was prevalent among both medical and non-medical students, with significantly higher scores among non-medical students (mean CIP score: of 67.08 ±13.704) compared to medical students (mean CIP score: 58.36 ±11.413. It was noted that although IP is prevalent in both genders, it is much more significant in females as females exhibited higher IP scores than males (p-value <0.05). The multivariate linear regression model showed significant dependency of the total CIP scores on the variables, university and gender, with the p-value being less than 0.05.

Conclusion: In conclusion, this study underscores the high prevalence of IP among medical and non-medical students and highlights the need for targeted interventions. It also explores the effect of both genders on having feelings of impostor-ism.

Pain Severity Ratings Among Patients with Comorbid Chronic Pain and PTSD: A Retrospective Cohort Study

2025-02-11T20:17:30-05:00

Background: Posttraumatic stress disorder (PTSD) is a psychiatric disorder that may occur after experiencing or witnessing a traumatic event. PTSD is characterized by physiological symptoms such as sleep disturbances and hyperarousal. One understudied symptom in PTSD patients is chronic pain (CP). Acute pain can lead to CP when it persists beyond adaptation. The interconnection between stress and pain has been well-established in fields of neuroscience and psychology, though we still do not fully understand the nature of this clinical relationship.

Methods: In the current retrospective cohort study, we use a sample of patients with PTSD and CP through a database of numerous healthcare organizations called TriNetX. We compare the reported pain severity rating between three groups: those with PTSD and no CP, those with CP and no PTSD, and those with comorbid PTSD and CP. The summary data was compared using a one-way analysis of variance with the Welch statistic.

Results: The average reported pain severity was significantly different between all three groups (F(2, 21288)=279.80, p < .001). The patients with comorbid PTSD and CP reported the highest average pain severity, followed by patients with only CP and then patients with only PTSD.

Conclusion: Our results demonstrate a need to further investigate the complex relationship between PTSD and CP. The higher average pain severity in patients with both disorders suggest that integrated pain management and mental health interventions must be prioritized in this population.

Comparison of serum PSA and IMPDH-2 in Predicting Aggressive Prostate Cancer: A Cross-sectional Study

2024-11-13T19:13:55-05:00

Background: Prostate cancer is a cause of morbidity and mortality among men globally. This study compared serum Prostate-Specific Antigen (PSA) and Inosine Monophosphate Dehydrogenase-2 (IMPDH-2) in predicting aggressive prostate cancer. Methods: Sixty-three prostate adenocarcinoma patients were recruited for this quantitative descriptive cross-sectional study. Their serum was assayed for IMPDH-2 and PSA. Serum IMPDH-2 and PSA correlations with Gleason score and ISUP Grade Groups were determined using Spearman’s rho and Kendall tau correlation coefficients, respectively. The magnitude of the correlation was assessed by calculating the coefficient of determination for the respective analysis (R2). Similarly, regression analysis and receiver operating characteristic (ROC) curve were used to assess the ability of the biomarkers to predict aggressive prostate cancer. Levels of statistical significance were set as p < 0.05. Results: The mean age was 68.6 years. The mean serum IMPDH-2 and PSA were 76.2pg/ml and 65.9ng/ml respectively. Serum IMPDH-2 did not predict aggressive prostate cancer; (r = 0.08, p = 0.55 Spearman rho), (τ = 0.03, p = 0.79 Kendal tau). Serum PSA weakly predicted aggressive prostate cancer; (r = 0.30, p = 0.02 Spearman rho), (τ = 0.21, p = 0.04 Kendal tau). It was responsible for 10.1 and 8.8% of Gleason score and ISUP grade group variances respectively. However, it did not significantly outperform IMPDH-2 in predicting the Gleason score (p = 0.53). Conclusion: PSA weakly predicted aggressive prostate cancer but did not statistically significantly outperform IMPDH-2. As such, none is sufficiently accurate in predicting aggressive prostate cancer when used in isolation

Diagnostic Performance of Western Blot for Congenital Toxoplasmosis: A Systematic Review and Meta-Analysis

2025-04-02T13:02:09-04:00

Background: Congenital toxoplasmosis results from infection with the parasite Toxoplasma gondii, which is transmitted from mother to child during pregnancy. Although Western blot is considered the most sensitive diagnostic tool for congenital toxoplasmosis, its diagnostic performance has not been subjected to meta-analysis. Methods: We conducted a systematic review and meta-analysis by performing literature searches across PubMed, Scopus, and Web of Science. The search strategy included the terms "western blot OR immunoblot" AND "congenital toxoplasmosis." The selected studies were required to meet specific inclusion criteria, which involved comparing the performance of the western blot test against the gold standard criteria for permanence of IgG after 10 months of age. These studies had to be case and control studies. The data obtained from the studies were then organized into an evidence synthesis table and the sensitivity, specificity, and Diagnostic Odds Ratio (DOR) index were calculated. This meta-analysis was performed in compliance with the recommendations of PRISMA guidelines. Results: After evaluating the selection criteria, we identified 44 articles; however, only 10 were selected for the meta-analysis. Western blot assay demonstrated a pooled sensitivity of 93.8% (95% CI: 79.2-98.4) and a pooled specificity of 96.6% (95% CI: 89.8-98.9) for the diagnosis of congenital toxoplasmosis. Six of the 10 studies had a DOR higher than 300, whereas the in-house method yielded a lower DOR of 1.2. Conclusions: This meta-analysis confirmed the utility of well-standardized western blot tests as a dependable diagnostic approach for congenital toxoplasmosis in terms of both sensitivity and specificity.

Effects of Blood Pressure Variability and Its Association With Dementia and Cognitive Impairment: A Systematic Review

2024-10-25T17:55:08-04:00

Background

This systematic review aimed to assess the relationship between blood pressure, cognitive function, and the potential for dementia in individuals with hypertension or at risk of developing hypertension.

Methods

The review adhered strictly to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A comprehensive search was conducted in databases, including PubMed, Research Gate, Google Scholar, and Science Direct. The inclusion criteria required studies that examined the association between blood pressure variability and the occurrence or progression of dementia and cognitive impairment. Two independent reviewers evaluated each study's quality and potential bias using study-specific tools before inclusion.

Results

There were a total of 17 studies, including four systematic reviews and meta-analysis, four randomized controlled trials, and nine observational studies, with a total of 16,985,492 participants. The findings indicated that late-life blood pressure had a stronger association with cognitive function than midlife blood pressure. Hypertension was linked to an increased risk of all-cause dementia, Alzheimer's disease, and vascular dementia. Anti-hypertensive medications could to reduce the risk of dementia or cognitive impairment, although the specific type of medication did not significantly affect overall cognitive performance. A significant limitation of this review was the heterogeneity in diagnostic criteria, cognitive assessment tools, and imaging techniques used among the studies, which limited direct comparisons and conclusive findings.

Conclusion

Blood pressure variability emerged as a potential predictor for cognitive impairment. Implementing strategies to reduce blood pressure variability may help mitigate the risk of dementia and improve cognitive outcomes in vulnerable populations.

Challenges and Gender Disparities Faced by Women in Surgery in Pakistan

2024-08-26T11:51:12-04:00

Medicine continues to face significant challenges in gender imbalance. The issue of gender discrepancy in the field of surgery has become more pronounced in low or middle-income countries like Pakistan due to the growing trend of women leaving the healthcare profession after completing education. Even fewer graduates go on to become surgeons. Female surgeons face clinical biases, excessive workloads and lack of recognition. Cultural norms and patriarchal mindsets impose additional challenges, making it difficult for female surgeons to balance professional and personal responsibilities, particularly motherhood. Gender biases in hiring, salary disparities, and a lack of institutional support further exacerbate the issue. Deeply ingrained preferences for male surgeons, with workplace harassment, reinforce the gender gap in operating theaters. This leads to stress, burnout, and lower job satisfaction causing fewer females to opt for surgical fields, creating gender disparity. In recent years, a newer trend has emerged with more females following their passion, but there is an increased need for support groups, proper mentorship programs, and implementation of equal opportunities for both males and females. It requires mentorship, institutional reforms promoting inclusive hiring, flexible work policies, and cultural shifts to challenge gender norms. Encouraging representation in surgical networks and advocacy groups fosters an inclusive and diverse surgical workforce.

Integrating Health and Education: A Medical Student’s Teaching Experience in a Government School

2025-02-18T21:35:17-05:00

This article outlines my experience as a part-time teacher in a government school through the NGO Teach For Change, alongside my medical education. The initiative aimed to promote social responsibility through education, with focus on health and hygiene. Key activities included organising extracurricular activities, health and hygiene education sessions, facilitating a health camp which was subsequently documented and published as a cross-sectional study, inspection of school environment and promoting home grown food. These efforts helped children learn about health in practical ways and encouraged healthy habits. Challenges included balancing intense medical training with teaching responsibilities, establishing rapport with the students, integrating health education into their existing academic curriculum. Despite the hurdles, it taught me valuable skills like time management, task prioritisation, communication, leadership and addressing real life difficulties in preventive medicine. In conclusion, such experiences benefit both the community and the individual. Integrating Heath education into school curriculum is crucial and encouraging medical students to engage in similar initiatives can foster social accountability, empathy, communication skills and reinforce the value of preventive care in medical practice.

A Case of Successful Surgical Resection of Locally Advanced (T4) Lung Cancer Utilizing a Multi-Disciplinary Approach Involving Previously Unresectable Structures

2025-03-03T23:28:16-05:00

Background:

Lung cancer is the leading cause of cancer death worldwide and the second most prevalent cancer in the world.(1) Tumor node metastasis (TNM) staging continues to serve as the primary prognostic factor for survival in lung cancer.

TNM classification (8^th edition) characterizes T4 disease as a tumor exceeding 7 cm in its largest dimension or one that invades structures such as the mediastinum, diaphragm, heart, great vessels, recurrent laryngeal nerve, carina, trachea, esophagus, spine or represents a separate tumor in a different lobe of ipsilateral lung.(2) These structures are typically deemed “unresectable”.(3)

Case:

We present the case of an asymptomatic 66-year-old gentleman with an incidental lung nodule found on routine pre-operative chest x ray. In this case, imaging revealed local extension, involving the stomach (excluded from TNM classification), diaphragm and pericardium. Consequently, the disease was initially considered incurable. Nevertheless, through collaborative multi-disciplinary surgical approach, successful resection was achieved.

Conclusion:

T4 disease exhibits heterogeneity, and although it is typically deemed unresectable, recent developments in surgery are challenging this conventional belief and demonstrating the potential benefits of surgical resection, particularly where a radical dissection is anticipated.

To Test or Not to Test? How a Positive Rapid Strep Test May Perplex the Diagnosis of Serum Sickness-Like Reaction in a Case Report

2025-03-22T15:52:59-04:00

Background: Serum sickness-like reaction (SSLR) is a rare cause of drug eruption. The clinical presentation includes fever, rash, and arthralgia which typically occurs 1-2 weeks after the administration of common antibiotics such as amoxicillin or cefaclor. It is a challenging diagnosis because it mimics sepsis and other exanthematous diseases. Rapid Strep Test (RST) is a useful diagnostic test for detecting Streptococcus pyogenes in patients with pharyngitis and Centor score of 3 or more guiding the administration of antibiotics.

The Case: We report a case of a 63-year-old female patient seen in the emergency department (ED) with high-grade fever, diffuse rash, musculoskeletal pain, and a positive RST without clinical evidence of pharyngitis. The primary care physician ordered the RST before the referral to the ED to investigate the febrile rash without a clear indication, misleading to the diagnosis of streptococcal sepsis. She was eventually diagnosed with SSLR and she was treated with corticosteroids, leading to rapid symptomatic relief.

Conclusion: SSLR is an interesting clinical entity, and its pathogenesis is poorly understood. This case emphasizes that SSLR is a clinical diagnosis of exclusion after ruling out other similar disorders. Physicians should be familiar with this benign condition to avoid unnecessary diagnostic testing such as RST which may misguide diagnosis and treatment. Simple diagnostic tests should be used with caution under certain indications; misuse of RST can cause false-positive results, complicating the management of these cases.

Uniting for Peace Through Science: A Call to Action from the IJMS and the 4th WCMSR

2025-05-20T15:28:02-04:00

Ending Nuclear Weapons, Before They End Us

2025-05-20T15:47:50-04:00